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Asha W, Al-Hilli Z, Djohan R, Budd GT, Obi E, Fleming-Hall E, Yang K, Grobmyer S, Cherian S, Tendulkar R, Shah C. Neoadjuvant Reirradiation for Radiation Therapy-Associated Angiosarcoma of the Breast. Int J Radiat Oncol Biol Phys 2024; 119:1082-1085. [PMID: 38191096 DOI: 10.1016/j.ijrobp.2023.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/23/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Radiation-associated angiosarcoma of the breast (RAASB) is a rare side effect after breast radiation and has been associated with poor outcomes. At this time, there is no consensus regarding management of RAASB, and the role of reirradiation remains controversial. We present our modern institutional outcomes in managing RAASB with incorporation of neoadjuvant hyperfractionated reirradiation. METHODS AND MATERIALS Patients identified were treated between 2016 and 2020 with inclusion of any histologically proven RAASB without metastatic disease at diagnosis, while excluding those with a history of radiation therapy outside of the breast/chest wall or other sarcoma histologies. Major wound complications were defined as requiring wound care and/or wound vacuum or return to the operating room for wound repair at any time after surgery. RESULTS Eight patients were identified, and the median follow-up was 34 months. Median time to RAASB development was 8 years from initial radiation therapy. With respect to RAASB management, all underwent surgery and neoadjuvant reirradiation therapy, and all but 1 patient received taxol-based chemotherapy. At last follow-up, 7 patients remained free of disease, and 1 patient died with distant disease. With respect to acute toxicity after reirradiation, all patients developed at least acute grade 2 toxicities. Five of the 8 patients developed a major wound complication. CONCLUSIONS Our institutional analysis suggests excellent local control and survival outcomes for RAASB treated with neoadjuvant hyperfractionated reirradiation, surgery, and taxol-based chemotherapy. However, major wound complications represent a major challenge with this approach. Future studies should consider how best to improve the therapeutic ratio while maintaining high rates of local control and survival.
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Affiliation(s)
- Wafa Asha
- Departments of Radiation Oncology, Taussig Cancer Institute
| | | | - Risal Djohan
- Plastic Surgery, Digestive Diseases and Surgery Institute
| | - G Thomas Budd
- Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Elizabeth Obi
- Departments of Radiation Oncology, Taussig Cancer Institute
| | | | - Kailin Yang
- Departments of Radiation Oncology, Taussig Cancer Institute
| | - Stephen Grobmyer
- Oncology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sheen Cherian
- Departments of Radiation Oncology, Taussig Cancer Institute
| | | | - Chirag Shah
- Departments of Radiation Oncology, Taussig Cancer Institute.
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Kwapnoski Z, Clarey D, Ma J, Schmidt CM, Wysong A. Cutaneous Angiosarcoma Subtypes: A Quantitative Systematic Review of Demographics, Treatments, and Outcomes Within Published Patient-Level Cases. Dermatol Surg 2024; 50:620-626. [PMID: 38530994 DOI: 10.1097/dss.0000000000004174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cutaneous angiosarcoma (cAS) is a highly aggressive malignancy arising from the vascular endothelium. Given its rarity, there is insufficient data detailing patient demographics, management, and survival outcomes. OBJECTIVE To systematically compile published patient-level cases of cAS and to quantify and analyze data on demographics, management, and outcomes while determining prognostic indicators. MATERIALS AND METHODS Searches of EBSCOhost, MEDLINE, EMBASE, and the Cochrane Library generated 1,500 cases of cAS with individual level data available. PRISMA guidelines were followed. RESULTS Cutaneous angiosarcoma presented most often on the scalp of elderly men. Metastasis occurred in 36.3% of cases. Aggregate 5-year survival was 31.6% with the median survival of 25 months. The best 5-year survival was in the radiation-associated subtype (48.8%), whereas the worst was in the Stewart-Treves subtype (21.6%). Using multivariate analysis, gender, age group, disease subtype, treatment modality, and metastasis at presentation had significant effects on survival outcomes ( p < .05). CONCLUSION The breadth of information obtained enables this study to serve as a resource that clinicians may reference when they encounter cAS.
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Affiliation(s)
- Zachary Kwapnoski
- Department of Dermatology, University of California Davis, Sacramento, CA
| | - Dillon Clarey
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE
| | - Jihyun Ma
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | - Cynthia M Schmidt
- University of Nebraska, Medical Center, Leon S. McGoogan Health Sciences Library, Omaha, NE
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE
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Pancsa T, Pósfai B, Schubert A, Almási S, Papp E, Chien YCC, Kálmán E, Kovács KA, Kulka J, Varga L, Cserni G, Kuthi L. TRPS1 expression in breast angiosarcoma. Virchows Arch 2024:10.1007/s00428-024-03852-2. [PMID: 38902365 DOI: 10.1007/s00428-024-03852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
Angiosarcoma (AS) of the breast, a rare mesenchymal neoplasm, exhibits distinct forms based on etiological and genetic features. While cases with typical clinical presentation and morphology allow for a straightforward diagnosis, challenges arise when clinical data are scarce, diagnostic material is limited, or morphological characteristics overlap with other tumors, including undifferentiated carcinomas. The trichorhinophalangeal syndrome protein 1 (TRPS1), once regarded as highly specific for breast carcinomas, now faces doubts regarding its reliability. This study explores TRPS1 expression in breast AS. Our investigation revealed that 60% of AS cases displayed TRPS1 labeling, contrasting with the 40% lacking expression. Scoring by four independent readers established a consensus, designating 12/35 ASs as unequivocally TRPS1-positive. However, uncertainty surrounded nine further cases due to a lack of reader agreement (being substantial as reflected by a kappa value of 0.76). These findings challenge the perceived specificity of TRPS1, shedding light on its presence in a noteworthy proportion of breast ASs. Consequently, the study underscores the importance of a comprehensive approach in evaluating breast ASs and expands the range of entities within the differential diagnosis associated with TRPS1 labeling.
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Affiliation(s)
- Tamás Pancsa
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Boglárka Pósfai
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anna Schubert
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Szintia Almási
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Eszter Papp
- Department of Surgical and Molecular Pathology, Tumor Pathology Center, National Institute of Oncology, Budapest, Hungary
| | - Yi-Che Chang Chien
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre Kálmán
- Department of Pathology, Faculty of Medicine and Clinical Center, University of Pécs, Pécs, Hungary
| | - Kristóf Attila Kovács
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Linda Varga
- Department of Oncotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Levente Kuthi
- Department of Surgical and Molecular Pathology, Tumor Pathology Center, National Institute of Oncology, Budapest, Hungary.
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary.
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Parisi S, Gambardella C, Iovino F, Ruggiero R, Lucido FS, Nesta G, Tolone S, Brusciano L, Fisone F, Mongardini FM, Cozzolino G, Della Corte CM, Napolitano S, Orditura M, Esposito R, Docimo L. Post-Irradiation Breast Angiosarcoma: All the Possible Treatments and Electrochemotherapy. Case Report and Literature Review. J Clin Med 2024; 13:567. [PMID: 38256700 PMCID: PMC10816174 DOI: 10.3390/jcm13020567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Breast angiosarcoma is a rare malignancy, accounting for less than 1% of all soft tissue cancers. It comprises primitive and secondary subtypes, such as radiogenic breast angiosarcoma (RAS). Despite multimodal treatment, angiosarcomas represent an incurable disease for many patients and a significant cause of deterioration in their quality of life. Surgery is a cornerstone in management, but high recurrence rates are reported. Electrochemotherapy (ECT) is a practicable locoregional treatment for patients with advanced angiosarcoma as part of a multimodal therapeutic strategy. The palliative benefits of ECT include optimal patient compliance, good local hemostasis control, and positive local responses. Since only 22 cases are described in the literature, we reported a rare case of RAS treated with ECT after a multidisciplinary approach, including Next Generation Sequencing (NGS). A literature review on the feasibility of ECT in RAS management was also performed.
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Affiliation(s)
- Simona Parisi
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Claudio Gambardella
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesco Iovino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
- Department of Translational Medical Sciences, Division of General Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Roberto Ruggiero
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesco Saverio Lucido
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Giusiana Nesta
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Salvatore Tolone
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Luigi Brusciano
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesca Fisone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Carminia Maria Della Corte
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Stefania Napolitano
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Ludovico Docimo
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
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Shaker N, Phelps R, Niedt G, Sangueza OP, Pradhan D. Diffuse Dermal Angiomatosis of Bilateral Breasts, A Distinct Entity of Reactive Angiomatoses: A Clinicopathologic Challenge. Am J Dermatopathol 2024; 46:60-61. [PMID: 38086087 DOI: 10.1097/dad.0000000000002587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Robert Phelps
- Departments of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Niedt
- Departments of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Omar P Sangueza
- Departments of Dermatology and Pathology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, NC; and
| | - Dinesh Pradhan
- Department of Dermatopathology, The University of Nebraska Medical Center, Omaha, NE
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Pasteris A, Pili N, Nonnis R, Marras V, Patetta R, Cossu A, Rubino C. A rare case of radiation-induced breast angiosarcoma: a case report. Case Reports Plast Surg Hand Surg 2023; 11:2296697. [PMID: 38179209 PMCID: PMC10763889 DOI: 10.1080/23320885.2023.2296697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
We describe a rare case of a 77-year-old woman with radiation-induced breast angiosarcoma (RIAS) in whom radical surgery with negative margins determined that at 14-month of follow-up there is no evidence of either local or systemic recurrence without having to resort to adjuvant chemotherapy.
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Affiliation(s)
- Andrea Pasteris
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Nicola Pili
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Rita Nonnis
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Vincenzo Marras
- Department of Biomedical Sciences,Institute of Pathology, University of Sassari, Sassari, Italy
| | | | - Antonio Cossu
- Department of Biomedical Sciences,Institute of Pathology, University of Sassari, Sassari, Italy
| | - Corrado Rubino
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
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7
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Takehara Y, Matsuda N, Kobayashi D, Yoshida A, Takei J, Kanomata N, Tsunoda H, Yamauchi H, Hayashi N. Radiation-induced angiosarcoma of the breast: individual participant meta-analysis of Japanese population. Breast Cancer 2023; 30:739-747. [PMID: 37261705 DOI: 10.1007/s12282-023-01466-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/29/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Radiation-induced angiosarcoma (RIAS) of the breast is a very rare and poor prognostic disease. According to previous studies, the efficacy of chemotherapy for RIAS is still controversial. However, no study has assessed the prognosis of RIAS and the prognostic impact of preoperative or postoperative chemotherapy in Japanese patients. Our study aimed to assess them in Japanese people using publication data with our three patients. METHODS Thirty-nine patients diagnosed with RIAS, including 36 patients from 34 published case series, and three patients from our hospital were used for analysis. Disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) were assessed. RESULTS Among the 39 patients, 36 patients (92.3%) underwent surgery. The median DFS and OS periods were 14 months (range 1-75 months) and 23 months (range 4-84 months), respectively. Chemotherapy with taxane-based regimen was administered in 13 cases (33.2%) pre- or post-operatively. DFS was significantly improved with chemotherapy in addition to surgery (p = 0.037). However, addition of chemotherapy to surgery did not improve DDFS (p = 0.09) and OS (p = 0.878). In multivariate analysis, age ≥ 70 years was an independent but poor prognostic factor of DFS. Additionally, a lack of chemotherapy showed a trend to be associated with worse DFS. There was no independent variable contributing to DDFS and OS. CONCLUSIONS Chemotherapy may have reduced the recurrence rate of RIAS in Japanese patients but did not improve OS. Further data are needed to confirm the efficacy and proper regimen of chemotherapy.
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Affiliation(s)
- Yuri Takehara
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Naoko Matsuda
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Daiki Kobayashi
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Junko Takei
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Kanomata
- Department of Pathology, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroko Tsunoda
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Naoki Hayashi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, Tokyo, Japan.
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Calle C, Zhong E, Hanna MG, Ventura K, Friedlander MA, Morrow M, Cody H, Brogi E. Changes in the Diagnoses of Breast Core Needle Biopsies on Second Review at a Tertiary Care Center: Implications for Surgical Management. Am J Surg Pathol 2023; 47:172-182. [PMID: 36638314 PMCID: PMC10464622 DOI: 10.1097/pas.0000000000002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Core needle biopsy (CNB) of breast lesions is routine for diagnosis and treatment planning. Despite refinement of diagnostic criteria, the diagnosis of breast lesions on CNB can be challenging. At many centers, including ours, confirmation of diagnoses rendered in other laboratories is required before treatment planning. We identified CNBs first diagnosed elsewhere that were reviewed in our department over the course of 1 year because the patients sought care at our center and in which a change in diagnosis had been recorded. The outside and in-house CNB diagnoses were then classified based on Breast WHO Fifth Edition diagnostic categories. The impact of the change in diagnosis was estimated based on the subsequent surgical management. Findings in follow-up surgical excisions (EXCs) were used for validation. In 2018, 4950 outside cases with CNB were reviewed at our center. A total of 403 CNBs diagnoses were discrepant. Of these, 147 had a change in the WHO diagnostic category: 80 (54%) CNBs had a more severe diagnosis and 44 (30%) a less severe diagnosis. In 23 (16%) CNBs, the change of diagnostic category had no impact on management. Intraductal proliferations (n=54), microinvasive carcinoma (n=18), and papillary lesions (n=35) were the most disputed diagnoses. The in-house CNB diagnosis was confirmed in most cases with available excisions. Following CNB reclassification, 22/147 (15%) lesions were not excised. A change affecting the surgical management at our center occurred in 2.5% of all CNBs. Our results support routine review of outside breast CNB as a clinically significant practice before definitive treatment.
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Affiliation(s)
- Catarina Calle
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
- Faculdade de Ciencias da Saude da Universidade da Beira Interior, Covilha, Portugal
| | - Elaine Zhong
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Matthew G. Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Katia Ventura
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Maria A. Friedlander
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
| | - Monica Morrow
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Hiram Cody
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, 10065 USA
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Semenov EV, Gasymly DD, Zyuzyukina AV, Zukov RA. Experience in the treatment of radioinduced angiosarcoma of the breast in a patient with primary multiple lesions of the breast and bladder. Case report. JOURNAL OF MODERN ONCOLOGY 2022. [DOI: 10.26442/18151434.2022.3.201687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Among the multiple primary malignant tumors, breast cancer is the most common and in most cases it is combined with the second mammary gland, uterine body, stomach, colon, skin and ovary. Breast angiosarcoma is a very rare disease with unfavorable prognosis. Radiation therapy to the area of the breast is considered to be the main risk factor for the radiation-induced angiosarcoma. Diagnosis is based on the clinical aspect, the results of morphological and immunohistochemical findings. There are no uniform standards for the treatment of this pathology; a surgical method, systemic therapy, and radiation therapy are used. The article presents a clinical case of a female patient born in 1952, who was diagnosed with synchronous multiple primary cancer in 2014: stage 2A left breast cancer (cT2N0M0); bladder cancer stage I (cT1cN0M0). After the complex treatment, the patient received adjuvant endocrine therapy with Tamoxifen. In December 2018, single bluish formations appeared in the area of the postoperative scar, followed by a rapid growth of formations on the skin within a month, with a tendency to merge and necrosis. The patient was sent for biopsy of the formations with suspected recurrence of the disease. Immunomorphological patterns correspond to the angiosarcoma in the skin of the mammary gland. A simple mastectomy was performed. After 3 months, growth of angiomyosarcoma in the soft tissues of the anterior chest wall continued. Excision of the tumor in the soft tissues of the chest was performed and the patient underwent postoperative course of radiation therapy with a single focal dose (SFD) 2.5 Gy, total boost isodose of 50 Gy. At follow-up examinations held from January to December 2021, there is no evidence for continued growth and recurrence of the disease. The presented clinical observation demonstrates the experience of diagnostics and treatment of radiation-induced angiosarcoma in the patient with multiple primary synchronous lesions of the breast and bladder.
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10
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Sato F, Yamamoto T. Breast Angiosarcoma after Primary Breast Cancer Surgery: A Systematic Review. J Plast Reconstr Aesthet Surg 2022; 75:2882-2889. [DOI: 10.1016/j.bjps.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
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Akhtar K, Abrari A, Shehwar D. Case report of post radiation angiosarcoma with “Dabska tumor” like features. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_197_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Notter M, Stutz E, Thomsen AR, Vaupel P. Radiation-Associated Angiosarcoma of the Breast and Chest Wall Treated with Thermography-Controlled, Contactless wIRA-Hyperthermia and Hypofractionated Re-Irradiation. Cancers (Basel) 2021; 13:cancers13153911. [PMID: 34359812 PMCID: PMC8345679 DOI: 10.3390/cancers13153911] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary This retrospective study reports on 10 patients with radiation-associated angiosarcoma of the breast and chest wall treated during the past decade. In this rare disease local control is highly dependent on the extent of surgery. Further treatment options are urgently needed. Re-iradiation in combination with localized hyperthermia should be considered for adjuvant and definitive treatment of nonresectable radiation-associated angiosarcomas. The presented hypofractionated re-irradiation schedule with 5 × 4 Gy once per week immediately following wIRA-hyperthermia is a promising option to further reduce the radiation dose recommended so far. This could reduce side effects without compromising local control. Abstract Background: Radiation-associated angiosarcoma of the breast (RAASB) is a rare, challenging disease, with surgery being the accepted basic therapeutic approach. In contrast, the role of adjuvant and systemic therapies is a subject of some controversy. Local recurrence rates reported in the literature are mostly heterogeneous and are highly dependent on the extent of surgery. In cases of locally recurrent or unresectable RAASB, prognosis is very poor. Methods: We retrospectively report on 10 consecutive RAASB patients, most of them presenting with locally recurrent or unresectable RAASB, which were treated with thermography-controlled water-filtered infrared-A (wIRA) superficial hyperthermia (HT) immediately followed by re-irradiation (re-RT). Patients with RAASB were graded based on their tumor extent before onset of radiotherapy (RT). Results: We recorded a local control (LC) rate dependent on tumor extent ranging from a high LC rate of 100% (two of two patients) in the adjuvant setting with an R0 or R2 resection to a limited LC rate of 33% (one of three patients) in patients with inoperable, macroscopic tumor lesions. Conclusion: Combined HT and re-RT should be considered as an option (a) for adjuvant treatment of RAASB, especially in cases with positive resection margins and after surgery of local recurrence (LR), and (b) for definitive treatment of unresectable RAASB.
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Affiliation(s)
- Markus Notter
- Radiation Oncology, Lindenhofspital Bern, 3012 Bern, Switzerland
- Members of the Swiss Hyperthermia Network, 5000 Aarau, Switzerland;
- Correspondence:
| | - Emanuel Stutz
- Members of the Swiss Hyperthermia Network, 5000 Aarau, Switzerland;
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Andreas R. Thomsen
- Department of Radiation Oncology, University Medical Center, University of Freiburg, 79106 Freiburg, Germany; (A.R.T.); (P.V.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Peter Vaupel
- Department of Radiation Oncology, University Medical Center, University of Freiburg, 79106 Freiburg, Germany; (A.R.T.); (P.V.)
- German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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de Oliveira LAA, de Pádua AF, Medeiros e Melo MA, Galvão ERDCGN, Vieira MC, Ibiapina JO, Fontinele DRDS, Vieira SC. Radiation-induced angiosarcoma: case report. EINSTEIN-SAO PAULO 2020; 18:eRC5439. [PMID: 33295433 PMCID: PMC7690932 DOI: 10.31744/einstein_journal/2020rc5439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/12/2020] [Indexed: 12/03/2022] Open
Abstract
Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named "radiogenic angiosarcoma of the breast", which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.
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Affiliation(s)
| | | | | | | | | | | | | | - Sabas Carlos Vieira
- Universidade Federal do PiauíTeresinaPIBrazilUniversidade Federal do Piauí, Teresina, PI, Brazil.
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Abbenante D, Malosso M, Raone B. Radiation-Induced Cutaneous Angiosarcoma of the Breast. Am J Med 2020; 133:1156-1157. [PMID: 32343946 DOI: 10.1016/j.amjmed.2020.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/21/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Diego Abbenante
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Marta Malosso
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Beatrice Raone
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Del Riego J, Pitarch M, Codina C, Nebot L, Andreu FJ, Aparicio O, Medina A, Martín A. Multimodality approach to the nipple-areolar complex: a pictorial review and diagnostic algorithm. Insights Imaging 2020; 11:89. [PMID: 32757082 PMCID: PMC7406635 DOI: 10.1186/s13244-020-00896-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/16/2020] [Indexed: 12/29/2022] Open
Abstract
The anatomic and histologic characteristics of the nipple-areolar complex make this breast region special. The nipple-areolar complex can be affected by abnormal development and a wide spectrum of pathological conditions, many of which have unspecific clinical and radiological presentations that can present a challenge for radiologists. The nipple-areolar complex requires a specific imaging workup in which a multimodal approach is essential. Radiologists need to know the different imaging modalities used to study the nipple-areolar complex, as well as their advantages and limitations. It is essential to get acquainted with the acquisition technique for each modality and the spectrum of findings for the different conditions. This review describes and illustrates a combined clinical and radiological approach to evaluate the nipple-areolar complex, emphasizing the findings for the normal morphology, developmental abnormalities, and the most common benign and malignant diseases that can affect this region. We also present a diagnostic algorithm that enables a rapid, practical approach to diagnosing condition involving the nipple-areolar complex.
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Affiliation(s)
- Javier Del Riego
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain. .,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain.
| | - Mireia Pitarch
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Clara Codina
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain
| | - Laura Nebot
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Oscar Aparicio
- Department of Surgery, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Alexandra Medina
- Department of Gynecology and Obstetrics, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, Barcelona, Spain
| | - Amaya Martín
- Department of Radiology, Women's Imaging, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Tauli I3PT, Univertitat Autònoma de Barcelona, 1 Parc Tauli, Sabadell, Barcelona, Spain.,Women's Imaging, Grup Duran Diagnòstic per la Imatge, Sabadell, Barcelona, Spain
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Khanal S, Chitrakar A, Nepal B, Sayami P, Singh YP. Secondary angiosarcoma in a hormone receptor negative breast cancer patient. J Surg Case Rep 2019; 2019:rjz166. [PMID: 31214308 PMCID: PMC6565830 DOI: 10.1093/jscr/rjz166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 11/24/2022] Open
Abstract
Post-irradiation angiosarcoma arising in the irradiated breast after breast‐conserving surgery is uncommon though being reported with increasing frequency. Such cases are reported mainly in hormone-receptor positive patients who had received hormonal therapy along with radiation. We describe a rare case of post-irradiation angiosarcoma in a 71-year-old hormone-receptor negative female who did not receive hormonal therapy.
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Affiliation(s)
- Suman Khanal
- Department of Gastrointestinal and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Akash Chitrakar
- Department of Gastrointestinal and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bikash Nepal
- Department of Surgery, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Prakash Sayami
- Department of General Surgery, Digestive Diseases and Laparoscopic Surgery, Grande International Hospital, Kathmandu, Nepal
| | - Yogendra P Singh
- Department of Gastrointestinal and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Wu WH, Ji QL, Li ZZ, Wang QN, Liu SY, Yu JF. Mammography and MRI manifestations of breast angiosarcoma. BMC WOMENS HEALTH 2019; 19:73. [PMID: 31182098 PMCID: PMC6558876 DOI: 10.1186/s12905-019-0769-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/20/2019] [Indexed: 01/18/2023]
Abstract
Background Breast angiosarcoma is rare and previous studies only focus on its pathology. This study aimed to summarize its imaging features. Methods Overall 17 patients pathologically confirmed with breast angiosarcoma were recruited. Eight patients underwent preoperative mammography, and 13 received preoperative MRI scan. The mammography and MRI findings were classified according to the ACR-BI-RADS-mammography/MR lexicon. Results Mammography showed that 3 cases developed diffuse asymmetry occupying two or more quadrants of the affected breast and that 5 patients had lobulated or oval masses. The 13 patients’ lesions presented as diffuse and slightly/significantly high homogeneous or heterogeneous signals on T1-weighted images, while the necrotic and cystic parts had relatively low signals. The hemorrhagic lesions in 7 cases had high signals on both T1- and T2-weighted images. A hemosiderin ring at the edge of an old hemorrhagic lesion had long and short signals on the T1- and T2-weighted images, respectively. Contrast-enhanced MRI revealed that the 13 patients’ lesions had significant heterogeneous enhancement. Significant enhancement was observed in the early phase, and varying degrees of concentric enhancement was seen in the delayed phase. Conclusions The mammography findings are nonspecific. MRI scan is helpful in determining the malignancy of the lesions. Breast angiosarcoma usually shows heterogeneous signals on both T1-weighted and T2-weighted images. Due to their incomplete lumens and lack of thrombocytes, patients with angiosarcoma have a higher incidence of bleeding (nearly 50% in this study) than those with other malignant tumors. The pattern of the enhancement curve helps to distinguish this disease from the typical types of breast cancer.
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Affiliation(s)
- Wen-Hai Wu
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Qing-Lin Ji
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Zhi-Zheng Li
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Qian-Nan Wang
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Shu-Ying Liu
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Jin-Fen Yu
- Magnetic Resonance Room, JiNan ZhangQiu District Hospital of TCM, ShanDong, 250200, China.
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